53 yo F was walking in high-heeled boots on the cobblestones of the west village. She slipped and suffered a knee twisting injury. On exam, she has an effusion but her plain film is negative for fracture/dislocation. She is in too much pain to bear weight but there is no appreciable laxity in the knee joint. Do you put her in a knee immobilizer or not?
ANSWER: NO knee immobilizer!
Many conferences ago, Dr. Leber reviewed the indications for a knee immobilizer for knee trauma: tibial plateau fracture, patellar fracture, patellar dislocation, quad or patellar tendon rupture, or a grossly unstable knee.
In our lady above, it is best to give her crutches with weight bearing and ROM as tolerated. If it’s an ACL or a meniscus injury (common sequelae of twisting the knee joint), prolonged immobilization may cause stiffness. Dr. Leber notes that many of these inappropriately prescribed knee immobilizers result in delays to definitive surgery because those patient often need physical therapy before surgery to regain their range of motion.
tibial plateau fracture:
www.med-ed.virginia.edu
Patellar fracture:
patellar dislocation:
Quad or patellar tendon rupture:
http://ortho-teaching.feinberg.northwestern.edu/cases/leg-knee/case7/case78additionalimages.html
